This is a great study and I'm surprised and impressed that morality dropped this much. This is one of the first RCT studies in a while (I think) to show such a clear mortality drop. After considering the benefits cash helps with such as safe delivery, reduced malnutrition and reduced maternal work - it makes a lot more sense.
One caveat to keep in mind is that this program cost around 30 million dollars and counterfactually saved about 90 infant lives. So that's about $300,000 per life saved. So cash is not a cost-effective intervention for saving lives alone (and it's not claiming to be).
Obviously they would have saved a lot more lives than that through reduced maternal mortality and under 5 mortality as well, through similar mechanisms. Maybe they'll measure that in future too....
I do wish other interventions had the opportunity to study these kind of things like cash does. Other interventions just don't get the great opportunities cash transfers do to probe all the potential benefits around the edges. It's pretty cool.
Still, has updated me on the effectiveness of cash that's for sure.
They do point out that the 30 million dollars was spread out among everyone, not just pregnant women. They take a guess at what the cost per life saved would be if it was targeted specifically at pregnant women:
targeting UCTs to women in the third trimester of pregnancy under these assumptions would cost about USD PPP 92,000 (or $39,000 in nominal dollars) per child death averted.
We should get more data on the actual cost-effectiveness in a while from the targeted givedirectly work.
100 percent agree. For sure the 30 million dollars is non-targeted (the child mortality benefit might not even make the top 3 or so benefits of cash). And yes the new study should give us more insight into the specific benefits of cash on child mortality. If anything I think the effect size will likely be smaller this study - 50% is a pretty insane start.
Yes, it's important to take into account that this is the finding of one study, whereas the mosquito net results come from a much more rigorous cochrane metastudy of many different studies.
Do you have more reasons to be skeptical of the 47% figure? After all, with 1000 bucks the household would be able to buy all the other interventions.
I'm only skeptical on priors, because 50 percent is an unusually huge infant mortality drop. I can't off the top of my head think of another right now like that measured in the last few years. I agree it feels plausible though and like your say 1000 dollars buys as lot. In the public health field we hardly ever see those kind of numbers even for expensive targeted interventions.
It’s reasonable to be somewhat skeptical based on priors given the statistical power of this (very worthy and interesting!) study? I didn’t dig deeper, but back of the envelope if you draw from 10000 iid households with an infant each and a 4% probability you’d expect a standard deviation around 0.2%, so there’s not much room for slicing the data a lot finer or additional correlation creeping in without a decent amount of sampling error. Obviously, with smarter analysis you can do a bit better and it’s hard and expensive to get more data, but it’s easy to believe the results are biased upwards a bit. The study is a great step in the right direction.
It's "a cost of USD PPP 299,418 per death averted," which is about $125,000 nominal USD based on the conversion implied by other parts of the article. At least to the extent that people are comparing to GiveWell estimates -- and I suspect most readers will be -- the nominal figure may be the better figure to highlight here.
While the broad cash program in this study is certainly more expensive per family than other global health programs, the researchers note that if the cash was targeted to pregnant women in their third trimester, it could be “comparably cost effective to a number of WHO-recommended maternal and child health interventions, even without taking into account other possible benefits of unconditional cash transfers (such as consumption gains).”
We’re launching a pilot this fall in Kenya specifically for pregnant women to learn just how much more cost-effectively cash can improve infant and maternal health, one of our many tests to improve our programs for specific outcomes.
Targeting UCTs to women in the third trimester of pregnancy under these assumptions would cost about USD PPP 92,000 (or $39,000 in nominal dollars) per child death averted. We can benchmark these calculations to 37 WHO-recommended maternal and child health interventions in East Africa as estimated by Stenberg et al. (2021). Across interventions and scenarios, the cost per death averted ranges from USD PPP 27 to USD PPP 222,952.[1] Hence, even without taking into account any of the other documented benefits of UCTs (such as gains in consumption), the transfers are squarely in the range of cost per death averted among these WHO-recommended interventions.
Article at p. 34 (footnote # is 36).
Stenberg et al. is here. Eastern sub-Saharan Africa is table 3. I'm not sure how to convert HLYs into deaths averted, but of the 37 interventions, #36 (ACER [2]of 1156.2) and #37 (ACER of 1310.6) are significantly less cost-effective than even #35 (ACER of 355.9). Based on the range in the article, it sounds like UCT-for-pregnant-women might rank somewhere between #35 and #36 here?
That doesn't sound like a particularly strong showing. The 27th out of 37 interventions has an ACER of 94.9. Some interventions I've seen discussed in EA circles are rated by Stenberg et. al much lower than even that: Vitamin A supplementation (0-4 years), 7.1; Kangaroo mother care, 20.1; Syphilis detection and treatment in pregnancy, 24.8.
Stenberg et al. (2021) evaluates cost-effectiveness using three coverage level scenarios: 50%, 80%, and 95%, and report health impacts in terms of healthy life years (HLY) saved. We converted HLYs to deaths averted using WHO data on total and healthy life expectancy in Kenya (World Health Organization, 2025).
I imagine that's the purpose of the trial - to optimise the programme for lifesaving and get that cost-per-life down.
They've already got data that villages nearer a physician show stronger benefit, timing on month of birth shows stronger benefit. I wouldn't be surprised to find other things (e.g. maternal age, child number, season in year, country, harvest quality) contributing and therefore optimisable, as well as the benefit/$ rising if the $ amount drops.
Also the 77% drop from a one-time intervention is already a huge whole-issue tackle that's going to have massive donor appeal (e.g. give $1000 to safeguard one child - this child). We had a Forum post some time back from someone expressing strong preference for knowing exactly where their money went. It's a very common donor preference.
Yes thanks for the reply. For sure cash here meets a WHO bar, as do a lot of health interventions. I used to quote the WHO bars a bunch but I'm not sure how useful they are practically as so many interventions meet those bars that we can't realistically fund them all.
I was implicitly considering cost effectiveness compared to GiveWell and open Philanthropy bars (as we often do here on the forum) which are a lot higher than the WHO's.
Really looking forward to the pilot in Kenya great job GiveDirectly team!
'even without taking into account other possible benefits of unconditional cash transfers (such as consumption gains)'
Presumably we'll know from the study when it comes out, which will be exciting, but if mother's are spending the money on services related to making their pregnancy/delivery safer, will they also receive the same amount of consumption gains? - I'd think these more general gains would be lower unless the pregnancy related costs are a lot less than the value of the transfer.
I don't have time to research this take, but one of my economist friends criticised this study for the following two reasons:
They claimed the averted deaths were in a famine, so there was regression to the mean (in a normal period there wouldn't have been so many deaths in the control)
They claimed the averted deaths were close to hospitals, so areas without existing healthcare infrastructure would not see this benefit so the counterfactual value of the money is less.
I haven't looked into this robustly so if someone has, please agree or disagree vote with this comment accordingly.
Do we have a sense of how well the well-studied benefits of UCT in a general population sample might be diminished to some extent in a month-of-birth sample?
From the study, it seems that the month-of-birth recipients spend their money in a manner that is meaningfully different than how a general sample spends the money. For example, one might expect a general population to spend relatively more on home improvements since it would not be spending nearly as much on improving birth outcomes. And to the extent that the month-of-birth sample used some of the money to reduce maternal labor while maintaining or improving consumption, it's not clear that this slice of expenditures would have the same spillover effects as most potential uses of the money.
That is to say that "the same $1,000 cash transfer improved" graphic looks fair for a general population but might not end up reflecting the non-mortality outcomes for a month-of-birth program. Or to state it differently, we might be looking at trading off some magnitude of certain classic GiveDirectly positive outcomes for better child/maternal health outcomes. I suspect it will be a tradeoff worth making, though.
Perhaps the most lifesaving consumption does not, but the drop in labor-force participation for a six-month period was pretty significant:
"In the
three months before and after a birth, however, cash transfers reduce female labor supply in
recipient households by 20.79 hours a week, relative to a control group mean of 40 hours . . . ."
What would also be interesting: Is there a sweetspot how much the money given to the women can be reduced while keeping the benefit of reduced deaths so costs go down and more persons can benefit.
Study: Giving cash to mothers cut infant deaths in half
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🤰🏽 A randomized study in Kenya found that giving families a $1,000 GiveDirectly cash transfer immediately cut infant deaths by 48%. →
🏥 Deaths dropped most for mothers living near physician-staffed health facilities and those who received cash in the weeks before they gave birth. →
🩺 GiveDirectly is launching a new program to maximize these life-saving impacts, partnering with a Kenyan community health provider to get cash to more expectant mothers. →
In rural Kenya, giving poor families a one-time $1,000 transfer cut infant deaths nearly in half, one of the largest reductions ever recorded for a poverty program. With global aid budgets shrinking and funders under pressure to do more with less, the findings point to cash as a powerful, underused tool to reduce preventable deaths.
Cash cut infant deaths by 48%
The study, led by researchers at UC Berkeley and Oxford, tracked over 100,000 births and found that infant mortality fell by 48% in the years families received a one-time $1,000 transfer from GiveDirectly.
It’s a striking result, reinforcing what decades of research have already shown: poverty itself is one of the biggest risk factors for a child’s survival. As the researchers note, “infant and child mortality appears highly sensitive to economic conditions.”
Cash saved lives by helping new moms rest, eat, and deliver safely
The biggest gains were among newborns: deaths within the first 30 days of a baby’s life fell by 63%, with drops in maternal and newborn causes of death accounting for more than half of the overall decline in infant deaths.
This drop was driven by a 45% increase in hospital deliveries and a 51% drop in work (often physically strenuous) during the third trimester and postpartum. Less work in late pregnancy coincided with fewer deaths from complications at birth.
When mothers have cash, they get care, proving that sometimes, the best way to save a child’s life is to simply give their mom money.
Cash had the largest impact when timed near birth and paired with access to healthcare
🗓️ Timing was critical. Researchers note that “gains in child survival are concentrated among women who received cash in the month they gave birth or shortly beforehand.” Transfers that came earlier or later had smaller impacts.
🏥 Access to healthcare was just as critical. Infant deaths fell more in villages closer to physician-staffed health facilities, where mothers could more easily access and afford existing high-quality health services.
The authors note that this pattern suggests “cash transfers can complement rather than substitute for investments in rural health infrastructure.”
Cash ranks among the best tools we have to save children’s lives
📊 Unconditional cash had impacts on par with top global health interventions. Our program reduced child deaths as much as giving out vaccines and anti-malarials, even though it wasn’t specifically designed to do so. This suggests direct cash should be a tool in the public health toolkit, working in complement with well-supported healthcare systems.[1]
⚖️ Our broad cash program in this study is certainly more expensive per family than other global health programs, especially those above. For more, see GiveWell's assessment of these results.
However, the researchers note that if the cash was targeted to pregnant women in their third trimester, it could be "comparably cost effective to a number of WHO-recommended maternal and child health interventions, even without taking into account other possible benefits of unconditional cash transfers (such as consumption gains)." That's why we're launching a pilot this fall in Kenya specifically for pregnant women to learn just how much more cost-effectively cash can improve infant and maternal health, one of our many tests to improve our programs for specific outcomes. Still, our programs will always have a higher cost per life saved than the programs in the table above.
💵 Cash also boosts many economic measures. Beyond saving lives, large lump sum transfers are proven to improve many dimensions of extreme poverty. An earlier study of the same Kenya program found this $1,000 directly reduced poverty and grew the local economy:
We’re building on this evidence with new maternal and newborn health programs
GiveDirectly will provide cash alongside existing health services to help women cover critical costs during pregnancy, childbirth, and postpartum recovery to maximize our impact.
We’ll be testing this model in two countries, with a similar program launching in the DRC with Panzi.
Cash is an underused tool to end preventable child deaths
This study adds to growing evidence that getting cash to the right households at the right time can prevent suffering before it happens.
With global aid budgets shrinking by $21 billion this year, health systems are under pressure to do more with less, and leaders are rethinking how to protect the most vulnerable.
As Bill Gates recently put it, we need new ways to “put the world on a path to ending preventable deaths of moms and babies.” This new study shows that cash has huge potential to accomplish that goal.
Appendix: How we know cash saved lives (Methods FAQs)
Cash is well-studied. Why haven’t we seen this impact before?
This is the first randomized controlled trial (RCT) large enough to reliably measure whether cash reduces child mortality.Previousstudies have shown that cash likely helps, but most used non-randomized methods that can’t fully rule out other explanations or were smaller in scale, making it harder to draw firm conclusions.
This is because studying mortality takes:
Enormous sample sizes: Deaths are typically measured per 1,000 births, so even meaningful changes are hard to detect without surveying tens of thousands of people.
Accurate birth data: Many places with high child mortality don’t have birth records, making it impossible to study changes in mortality over time.
Then how was this study able to measure the link between mortality and cash?
Two rare conditions came together:
Large, randomized cash program: Between 2014 and 2017, GiveDirectly delivered $1,000 to over 10,500 households across 653 villages in rural Siaya, Kenya. Villages were randomly assigned to receive cash or not, allowing researchers to measure effects on both recipients and their neighbors.
Accurate, long-term birth survey: Like most places facing extreme poverty, Siaya, Kenya had no reliable birth records. To fill the gap, researchers supported by GiveWell ran a full census in 2023, surveying 107,000 women and recording over 100,000 births going back to 2011.
With these conditions, researchers could finally isolate the impact of cash on mortality at a sufficient scale.
Explore the map below to see the study area, including treatment and control villages. Proximity helped researchers measure both individual impacts and broader effects across communities.
How do they track 100,000 births with no hospital records?
To fill the gap of incomplete birth and death records, researchers used verbal autopsies: structured, in-person interviews with caregivers. This method is standardized, endorsed by the World Health Organization, and widely used when medical records aren’t available.
Teams went door-to-door across the study area to collect these histories, building the most complete picture possible of births and child survival over the study period.
Our goal with this comparative table is to show that the effect size of cash was large -- comparable to other very effective global health interventions. This means unconditional cash is a promising tool for public health, which is not currently a commonly held belief.
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This is a great study and I'm surprised and impressed that morality dropped this much. This is one of the first RCT studies in a while (I think) to show such a clear mortality drop. After considering the benefits cash helps with such as safe delivery, reduced malnutrition and reduced maternal work - it makes a lot more sense.
One caveat to keep in mind is that this program cost around 30 million dollars and counterfactually saved about 90 infant lives. So that's about $300,000 per life saved. So cash is not a cost-effective intervention for saving lives alone (and it's not claiming to be).
Obviously they would have saved a lot more lives than that through reduced maternal mortality and under 5 mortality as well, through similar mechanisms. Maybe they'll measure that in future too....
I do wish other interventions had the opportunity to study these kind of things like cash does. Other interventions just don't get the great opportunities cash transfers do to probe all the potential benefits around the edges. It's pretty cool.
Still, has updated me on the effectiveness of cash that's for sure.
They do point out that the 30 million dollars was spread out among everyone, not just pregnant women. They take a guess at what the cost per life saved would be if it was targeted specifically at pregnant women:
We should get more data on the actual cost-effectiveness in a while from the targeted givedirectly work.
100 percent agree. For sure the 30 million dollars is non-targeted (the child mortality benefit might not even make the top 3 or so benefits of cash). And yes the new study should give us more insight into the specific benefits of cash on child mortality. If anything I think the effect size will likely be smaller this study - 50% is a pretty insane start.
Yes, it's important to take into account that this is the finding of one study, whereas the mosquito net results come from a much more rigorous cochrane metastudy of many different studies.
Do you have more reasons to be skeptical of the 47% figure? After all, with 1000 bucks the household would be able to buy all the other interventions.
I'm only skeptical on priors, because 50 percent is an unusually huge infant mortality drop. I can't off the top of my head think of another right now like that measured in the last few years. I agree it feels plausible though and like your say 1000 dollars buys as lot. In the public health field we hardly ever see those kind of numbers even for expensive targeted interventions.
It’s reasonable to be somewhat skeptical based on priors given the statistical power of this (very worthy and interesting!) study? I didn’t dig deeper, but back of the envelope if you draw from 10000 iid households with an infant each and a 4% probability you’d expect a standard deviation around 0.2%, so there’s not much room for slicing the data a lot finer or additional correlation creeping in without a decent amount of sampling error. Obviously, with smarter analysis you can do a bit better and it’s hard and expensive to get more data, but it’s easy to believe the results are biased upwards a bit. The study is a great step in the right direction.
It's "a cost of USD PPP 299,418 per death averted," which is about $125,000 nominal USD based on the conversion implied by other parts of the article. At least to the extent that people are comparing to GiveWell estimates -- and I suspect most readers will be -- the nominal figure may be the better figure to highlight here.
While the broad cash program in this study is certainly more expensive per family than other global health programs, the researchers note that if the cash was targeted to pregnant women in their third trimester, it could be “comparably cost effective to a number of WHO-recommended maternal and child health interventions, even without taking into account other possible benefits of unconditional cash transfers (such as consumption gains).”
We’re launching a pilot this fall in Kenya specifically for pregnant women to learn just how much more cost-effectively cash can improve infant and maternal health, one of our many tests to improve our programs for specific outcomes.
(updated our post above to clarify this)
Adding this quote for context:
Targeting UCTs to women in the third trimester of pregnancy under these assumptions
would cost about USD PPP 92,000 (or $39,000 in nominal dollars) per child death averted.
We can benchmark these calculations to 37 WHO-recommended maternal and child health
interventions in East Africa as estimated by Stenberg et al. (2021). Across interventions
and scenarios, the cost per death averted ranges from USD PPP 27 to USD PPP 222,952.[1]
Hence, even without taking into account any of the other documented benefits of UCTs (such
as gains in consumption), the transfers are squarely in the range of cost per death averted
among these WHO-recommended interventions.
Article at p. 34 (footnote # is 36).
Stenberg et al. is here. Eastern sub-Saharan Africa is table 3. I'm not sure how to convert HLYs into deaths averted, but of the 37 interventions, #36 (ACER [2]of 1156.2) and #37 (ACER of 1310.6) are significantly less cost-effective than even #35 (ACER of 355.9). Based on the range in the article, it sounds like UCT-for-pregnant-women might rank somewhere between #35 and #36 here?
That doesn't sound like a particularly strong showing. The 27th out of 37 interventions has an ACER of 94.9. Some interventions I've seen discussed in EA circles are rated by Stenberg et. al much lower than even that: Vitamin A supplementation (0-4 years), 7.1; Kangaroo mother care, 20.1; Syphilis detection and treatment in pregnancy, 24.8.
Stenberg et al. (2021) evaluates cost-effectiveness using three coverage level scenarios: 50%, 80%, and 95%, and report health impacts in terms of healthy life years (HLY) saved. We converted HLYs to deaths averted using WHO data on total and healthy life expectancy in Kenya (World Health Organization, 2025).
"The average cost-effectiveness ratios (ACERs) were calculated by dividing the total cost for scale-up by the total health gain."
I imagine that's the purpose of the trial - to optimise the programme for lifesaving and get that cost-per-life down.
They've already got data that villages nearer a physician show stronger benefit, timing on month of birth shows stronger benefit. I wouldn't be surprised to find other things (e.g. maternal age, child number, season in year, country, harvest quality) contributing and therefore optimisable, as well as the benefit/$ rising if the $ amount drops.
Also the 77% drop from a one-time intervention is already a huge whole-issue tackle that's going to have massive donor appeal (e.g. give $1000 to safeguard one child - this child). We had a Forum post some time back from someone expressing strong preference for knowing exactly where their money went. It's a very common donor preference.
Well done GiveDirectly!
Yes thanks for the reply. For sure cash here meets a WHO bar, as do a lot of health interventions. I used to quote the WHO bars a bunch but I'm not sure how useful they are practically as so many interventions meet those bars that we can't realistically fund them all.
I was implicitly considering cost effectiveness compared to GiveWell and open Philanthropy bars (as we often do here on the forum) which are a lot higher than the WHO's.
Really looking forward to the pilot in Kenya great job GiveDirectly team!
'even without taking into account other possible benefits of unconditional cash transfers (such as consumption gains)'
Presumably we'll know from the study when it comes out, which will be exciting, but if mother's are spending the money on services related to making their pregnancy/delivery safer, will they also receive the same amount of consumption gains? - I'd think these more general gains would be lower unless the pregnancy related costs are a lot less than the value of the transfer.